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This report provides an overview of the health of women in the European Community, highlighting both differences and similarities within and between the Member States.
Commission Report of 22 May 1997 on the state of women's health in the European Community [COM(97) 224 final - Not published in the Official Journal]
The report examines the main causes of mortality and morbidity as well as a number of individual and social determinants which influence women's health within the context of evolving demographic and social trends.
The main sources of data are:
- the World Health Organisation's "Health for All" database;
- various reports and data from EUROSTAT;
- an EC-wide Eurobarometer survey carried out in early 1996.
The data obtained are somewhat limited in their comprehensiveness and comparability. These constraints narrow the range of subjects dealt with in the report.
The report focuses on women aged 15 years and older, because most gender-specific health data at EC level concentrate on this age-group.
Social and demographic trends
Women account for 51.2% of the population of the European Community. This percentage is very stable across the Member States, varying from a 50.4% in Ireland to 51.8% in Portugal.
There is considerable variation in the percentage of women across age-groups: in the group of women under 20 years of age, there are 95 women for every 100 men, while among 80-year-olds there are about 221 women for every 100 men. This degree of variation can be partly explained by the difference in life expectancy, with that of women having significantly increased to reach 80 years old, six years more than the average expectancy for men.
There have been considerable changes in family life. The rate of marriage has declined significantly, from 8 to 5.1 marriages for every 1 000 persons in the period from 1960 to 1995. At the same time, the rate of divorce has more than tripled, from 0.54 to 1.8 for every 1 000 persons (except in Ireland). The average age of first marriage and the age at first birth have risen to 26.1 and 28.6 years respectively.
Women's labour force participation has increased tremendously, although there are very considerable variations across the Member States, ranging from 70% in the Nordic countries (where there exists the greater equality between sexes) to 40% in southern Europe. Concomitant with this trend has been an increase in part-time work (between 70% and 90% of part-time jobs are done by women) and temporary employment. Women are affected more than men by unemployment.
Selected health indicators
Infant mortality has fallen sharply in the Community; only 6.9 baby girls out of 1 000 live births die before the age of 1 year, which represents a decline of 68% since 1970. Maternal mortality rates have also declined significantly (by 79% since 1970) to 7 deaths per 100 000 women in 1992.
62% of women in the Community consider themselves to be in good or very good health, although this figure obscures very considerable variations between Member States, ranging from 75.8% in Ireland to 34.7% in Portugal.
The average height of women has increased over the last few decades, and is now 163.5 cm. Dutch women average a height of 167.9 cm, while Portuguese women average 159.6 cm.
Since there are no disease-specific morbidity measures at Community level, indirect measures such as short- and long-term disability and health care utilisation have been used.
On average, almost one out of every four women report limitations in their daily activities to some extent (17.3%) or severely (6.3%) because of long-standing illness. This average varies from a high of 30% in Finland and Portugal to a low of 15% in Luxembourg, and increases with age.
The rate of temporary activity limitation is fairly low in absolute terms, although 14% of women report having had to cut down on their activities in the past two weeks because of illness or injury. The lowest rate is in Italy (5.6%) and the highest in the Netherlands (20%).
On average, one out of three women has consulted with a physician in person or by telephone in the past two weeks (ranging from 25% in Ireland and the Netherlands to 38% in Spain). An average of 10% of women in the Community report having had one or more (non-birth) hospitalisations in the past year, staying a total of about 10 days in the hospital. There is a considerable variation in this figure between Denmark (3.8%) and France and Finland (13%). Older women are twice as likely as younger women to have been hospitalised, and they tend to stay longer as well.
Causes of death and trends in female mortality
Across all ages, the most frequent causes of death among women are diseases of the circulatory system (accounting for 43% of all deaths), cancer (26%), diseases of the respiratory system (6%) and suicide and accidents (5%).
The major causes of death vary with age:
- for women under 30, motor vehicle accidents are the main cause of death;
- in the 30-34 age-group, the main cause is suicide;
- for women aged 35-64, the main cause of death is cancer, particularly breast and cervical cancer;
- for women aged 65 and over, diseases of the circulatory system account for almost half of all deaths.
Health determinants and health promotion
To a very large extent, the two major causes of mortality (heart disease and cancer) are preventable through primary (healthier lifestyles) or secondary prevention (early detection through, for example, screening). The main risk factors associated with much premature mortality (death before the age of 65) include smoking, excessive alcohol consumption, unhealthy diet and lack of exercise.
In most Member States, about 25% of women smoke, and this figure is increasing continually. Denmark and Portugal stand out because of their respectively very high (42%) and very low rates (12%) of smoking among women. Smoking is the main risk factor in about 30% of cancers and is a major factor in cardiovascular diseases.
There are no data available on average alcohol consumption among women. However, it is known that women drink less than men, although this gap between the sexes is gradually getting smaller. Immoderate consumption increases the risk of liver complaints, diseases of the circulatory system and certain types of cancer.
Even though data on diet are scarce, analyses can draw on data on the outcome of eating patterns, i.e. weight. In the Community, one out of every five women is overweight as measured by the body mass index (BMI), while 15% are underweight. The highest incidences of excess weight are in Greece (33.2%) and Portugal (28.5%), and the lowest in France (15.5%) and Denmark (16.6%). Being overweight is a significant risk factor for heart disease, diabetes and cancer.
The frequency and types of health check-ups for women vary considerably by age-group and by country. For example, 44% of women aged 65 or over have had a heart check-up in the past year, compared with only 10% among women aged under 35. In Germany, 35.3% of women have had a heart check-up, whilst the figure for the Netherlands is 9.7%.
As regards diabetes, around 22% of women have had a diabetes test in the past year, although the figure is 44% among overweight women aged 40 and over. There is considerable variation between Member States: Germany reports the highest rate of testing (35.3%), with the lowest rates being reported in the Netherlands and Sweden (9.7% and 12.8% respectively).
Around 16% of women in the Community report having had an osteoporosis test in the past year. The rate of testing ranges from 4% in Finland to 28% in Austria.
Thanks to the various programmes at national and Community level, the rate of cancer screening is very high. Almost 40% of women report having had a cervical smear in the previous year, although the figure varies considerably between Member States, from 15.8% in Ireland to 63.5% in Denmark.
Similarly, almost 40% of women report having performed a breast self-examination in the previous year, and 18% report having had a mammography during the same period. Some Member States have introduced systematic screening programmes which have had a significant impact on the cancer mortality rate. Moreover, 90% of women endorsed free mammography screening.
Special issues in women's health
Several health issues have emerged over the past few years because of their particular importance for women:
- There is a lack of data on the incidence and prevalence of eating disorders (bulimia and anorexia nervosa), although the perception is that it has been increasing throughout the Community over the last 20 years. One study puts the mortality rate among anorexia suffers at 6% (suicide, heart attack) and at 3% for those with bulimia.
- At the end of 1996, women accounted for 17% of AIDS sufferers, and this percentage was on the increase. Most of these women were intravenous drug users. The main transmission routes of HIV among women vary between Member States: intravenous drug use in Spain, Italy, Portugal, Ireland and heterosexual transmission in Belgium. Men are more likely to transmit HIV to women than vice versa. Preventive interventions aimed at women have in general been limited.
- Availability of contraceptives and abortion are important issues for women of reproductive age. Most Member States report contraceptive use rates between 71% and 81%, except for Spain (59%) and Portugal (66%). The most widely used method of contraception is the birth control pill, followed by the condom. The choice of contraceptive method is influenced by a variety of factors, particularly health risks and the side-effects associated with a particular method, as well as the age of the woman (younger women favour the use of birth control pills or condoms, while older women may prefer IUDs or surgical sterilisation). Abortion is permitted, under varying criteria/conditions, in all Member States except Ireland and Northern Ireland. Abortion rates per 1 000 women vary from one Member State to another, ranging from 18.3 in Sweden to 5.4 in Spain.
- the average age at menopause is 50-52 years. Its effects on women's health vary: 75% of menopausal women experience some problems or discomfort, but only 10-20% seek medical help. The increasing longevity of women has intensified the debate about the possible long-term consequences of menopause. Although there is currently no proof of a causal link between post-menopausal hormone levels and health, morbidity statistics reveal increased incidence of cardiovascular disease and osteoporosis in post-menopausal women. Hormone replacement therapy (HRT) is still surrounded by controversy; rates of HRT use are estimated at 2% in Italy and 56% in Finland. It should be noted that a large majority of women feel that they are not being properly informed about the advantages and cost of this treatment.
- Violence against women is gradually being recognised as a public health issue because of both the physical and psychological harm it causes. Although data are scarce, it is now recognised that violence against women by a male partner is the most endemic form of violence. It is estimated that between one woman in three (Portugal and Germany) and one woman in five (Ireland) are victims of domestic violence.
In overall terms, the conclusion may be drawn that women in Europe are in good health and feel quite healthy. However, the report emphasises the improvements needed as regards preventive measures and the provision of information, and also the need to recognise that some health problems are specific to women.